Systems and methods for fusion of anatomical joints

ABSTRACT

The present disclosure relates to improved plate and screw systems for use in fusion and other surgical procedures, which improve the ability to effectively affix adjacent bodies without gapping or experiencing loss of compression over time. The systems include plates having armatures configured to receive bushings, the bushings configured to pivot and rotate and thereby permit a greater degree of orientation of corresponding screws placed through the bushings. In embodiments, the bushings comprise anti-rotation elements which lock the bushings in a desired orientation. Methods for use of the components described herein are also disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.16/424,050, filed on May 28, 2019, which in turn claims the benefit ofU.S. Provisional Patent Application Ser. No. 62/676,635, filed May 25,2018, the entireties of which are incorporated by reference herein.

FIELD

The present disclosure generally relates to the field of medicaldevices, and more specifically to systems for use in fusion and othersurgical procedures. Methods for using the foregoing devices are alsodisclosed herein.

BACKGROUND

Surgeries on joints in the human body often require fixation of two ormore adjacent bodies, including where those bodies are intended forpost-fusion articulation. A “fusion” is a commonly used surgicalprocedure where two or more adjacent bodies are joined together. Fusionalso commonly involves the use of plates, screws and other devices intoa small surgical site. Given the size of the plates, screws and otherdevices used in these types of surgeries, the complexities of theassociated surgical procedures, as well as other factors, it is oftenchallenging to provide a device or implant that is adequate for use in asuccessful fusion surgery, and that otherwise meets the surgical plan.Such surgical procedures often require introduction of additional toolsto prepare the surgical site, including drills, drill guides,debridement tools, irrigation devices, clamps, pins, cannula and othertools.

Many prior art plates and screw systems suffer from significantdisadvantages, such as large footprint, excessive prominence, poorplacement, inaccurate trajectory, poor stability/flexibility, difficultyin handling, loss of permanent fixation/subsidence, impaired visibilityand other disadvantages. These disadvantages often result in arelatively high rate of failure or discomfort, particularly when appliedto the foot or ankle of a patient. Further, many plate systems aredesigned for only a specific type of type, size or shape of screw, andtherefore limit their applicability.

Other plating systems do not provide flexibility with respect toorientation of the plate and/or screws, limiting their applicability andcausing discomfort/pain to the patient. For instance, many plates do notprovide a wide degree of orientation of a screw placed through thebore(s) of the plate. This in turn creates difficulty when attemptingshallow angles of penetration through the plate and patient's boneyanatomy. Further problems exist in prior art plating systems thatcomprise multiple bores and do not sufficiently protect againstintersecting screw trajectories.

There is also an increasing benefit of performing fusion and otherprocedures by a minimally-invasive surgery (“MIS”). During a MISprocedure, a less destructive/invasive approach to the patient iscarried out, which may involve the use of much smaller retractors thanan “open” procedure, and which in turn limit the potential damage tointervening anatomical landmarks. Plates and screws must meet additionalcriteria for use in MIS procedures, which are often unmet by existingsystems.

It would therefore be advantageous to provide a system and method forachieving fusion that significantly reduces, if not eliminates, theshortcoming, problems and risks noted above. Other advantages over theprior art will become known upon review of the Summary and DetailedDescription sections herein.

SUMMARY

According to various embodiments presented herein, the presentdisclosure describes improved plate and screw systems for use in fusionand other surgical procedures. More specifically, the systems describedbelow greatly improve the ability to effectively affix adjacent bodieswithout gapping or experiencing loss of compression over time.

In one aspect of the present disclosure, the systems and methods providea plate comprising one or more armatures for placement of screws in aconverging arrangement, which in turn promotes the objectives describedherein.

In another aspect of the present disclosure, the systems and methodspermit components to be introduced during a minimally-invasive surgicalprocedure.

In yet another aspect of the present disclosure, the plate comprises oneor more retaining collars for securing a compression-type orpolyaxial-type screw.

In yet another aspect of the present disclosure, the collars are adaptedto receive a bushing for adjusting orientation of a screw or equivalentfastener extending therethrough. In one embodiment, the bushing isthreaded. In another embodiment, the bushing is dual-threaded. In yetanother embodiment, the bushing comprises a cam, a slope orequivalently-shaped surface to provide an orientation to a screw orequivalent fastener inserted therethrough.

In yet another aspect of the present disclosure, the armature(s) and/orcollar(s) described herein provide flexible orientation of a screw orequivalent fastener passing therethrough, while maintaining adequatespacing among the various trajectories achievable with the system.

In yet another aspect of the present disclosure, the systems and methodsprovide for insertion of multiple screws or equivalent fasteners in aplane(s) offset by about 90 degrees. In this manner, the systems andmethods achieve greater compression and avoid gapping and other problemsassociated with prior art systems and methods.

In one embodiment, the system comprises: a plate having one or morearmatures, each of the one or more armatures offset from thelongitudinal or x-axis of the plate; the one or more armaturescomprising a recess having an inner surface; a bushing having an outersurface complementary to the inner surface of the recess and configuredto be received by and retained by the recess, wherein the bushingfurther comprises a through hole accessible via the recess when thebushing is retained therein; a screw comprising a threaded portion, anon-threaded portion and a screw head complementary to the through holeof the bushing, wherein the threaded and non-threaded portions of thescrew pass through the through hole of the bushing, wherein the screwhead is captured by the through hole of the bushing, and whereinrotation of the screw once the screw head is captured by the bushingrotates the bushing relative to the recess; and wherein further rotationof the bushing secures the position of the bushing relative to therecess, thereby locking the bushing and the screw in a fixed orientationrelative to the plate.

According to another embodiment, the system comprises: a thin platehaving a longitudinal or x-axis and first and second medial sides, theplate comprising one or more generally cylindrical bores extendingtherethrough; the plate further comprising two or more armaturesextending from the first or second medial side of the plate; the two ormore armatures comprising a recess having an inner surface and a notchlocated along the inner surface; each of the two or more armaturesadapted to receive a bushing configured to fit within the recess of thecorresponding armature and having an outer profile that is complementaryto the inner surface of the recess within which it is received, thebushings permitted to pivot or rotate within the recesses; each bushinghaving at least one outwardly-extending protrusion; and wherein thebushing is prevented from pivoting or rotating once theoutwardly-extending protrusion configured to engage the notch along theinner surface of the recess.

In yet another embodiment, the system comprises: a plate comprising oneor more armatures, each of the one or more armatures offset from andextending about 90 degrees to the x-axis of the plate; the platecomprising at least one bore configured to receive a first screworiented in a z-axis relative to the plate; the one or more armaturescomprising a recess located at a distal end of the armature and havingan inner surface; a bushing having an outer surface complementary to theinner surface of the recess and configured to be selectively received byand retained by the recess, wherein the bushing further comprises athrough hole accessible via the recess when the bushing is retainedtherein; a second screw comprising a threaded portion, a non-threadedportion and a screw head having an outer surface complementary to thethrough hole of the bushing, wherein the threaded and non-threadedportions of the second screw pass through the through hole of thebushing, and wherein the outer surface of the screw head is configuredto be retained within the through hole of the bushing, and wherein thesecond screw is oriented in the direction of and normal to theorientation of the first screw.

In yet another embodiment, the present disclosure relates to an assemblycomprising:

-   -   a thin plate having first and second sides, the thin plate        comprising one or more cylindrical bores extending therethrough;    -   the thin plate further comprising two or more armatures        extending from the first or second side of the plate;    -   the two or more armatures comprising a recess having an inner        surface and a notch located along the inner surface;    -   each of the two or more armatures adapted to receive a bushing        configured to fit within the recess of the corresponding        armature and having an outer profile that is complementary to        the inner surface of the recess within which it is received, the        bushings permitted to pivot or rotate within the recesses;    -   each bushing having at least one outwardly-extending protrusion;        and

wherein the bushing is prevented from pivoting or rotating once theoutwardly-extending protrusion engages the notch along the inner surfaceof the recess. In yet another embodiment, the disclosure relates to anorthopedic implant system comprising a spanning link having alongitudinal axis in the x direction and having a first spanning linkfastener with a first spanning link fastener axis which forms an anglerelative to the spanning link longitudinal axis of from 80 degrees to100 degrees, and a first leg link extending away in the y and zdirection from the of the spanning link longitudinal axis and having afirst leg link fastener aperture that receives a first leg link fastenerwhich has a first leg link fastener axis that extends away from thefirst leg link fastener aperture in the direction of but notintersecting the first spanning link fastener axis.

In yet another embodiment, the disclosure relates to an orthopedicimplant system, comprising:

-   -   a spanning link having a longitudinal axis in the x direction        and having a first spanning link fastener aperture that receives        a first spanning link fastener with a first spanning link        fastener axis which forms an angle relative to the spanning link        longitudinal axis of from 80 degrees to 100 degrees and having a        second spanning link fastener aperture that receives a second        spanning link fastener with a second spanning link fastener axis        which forms an angle relative to the spanning link longitudinal        axis of from 80 degrees to 100 degrees and the spanning link        defining a fusion area located between the first spanning link        fastener and the second spanning link fastener;    -   a first leg link extending away in the y-z direction having a        first leg link length from the spanning link longitudinal axis        and having a first leg link fastener aperture which receives a        first leg link fastener which has a first leg link fastener axis        that extends away from the first leg link fastener aperture in        the direction of the fusion area;    -   a second leg link extending away in the y-z direction having a        second leg link length from the spanning link longitudinal axis        and having a second leg link fastener aperture which receives a        second leg link fastener which has a second leg link fastener        axis that extends away from the second leg link fastener        aperture in the direction of the fusion area; and    -   wherein the first leg link fastener axis and the second leg link        fastener axis converge toward each other, but do not intersect.

In yet another embodiment, the disclosure relates to an orthopedicimplant system having an outline consisting of a single spanning linkthat extends from 15 to 60 mm along a long axis and has two opposingterminal ends joined across a short axis at a width of 2 to 5 mm by twoopposing long sides, and each of the terminal ends include a throughaperture each of which receives a cross screw at least one the crossscrews being a polyaxial compression screw, and wherein the cross screwaxes are in differing planes and form an X-shape but which do notcontact each other.

In yet another embodiment, the disclosure relates to an implant whichcomprises a first long curved spanning link having a top surface and amedial line along its length and a first end having a first ear having afirst fastener aperture and a second end having a second ear having asecond fastener aperture and the long spanning link is fixed at thefirst end by a first fastener that extends through the first fasteneraperture at 90 degrees +/−10 degrees to the medial line of the spanninglink and aperture and the long spanning link is fixed at the second endby a second fastener that extends through the second fastener apertureat 90 degrees +/−10 degrees to the medial line of the spanning link, afirst leg link and a second leg link each extending away from the medialline of the spanning link and the first leg link and the second leg linkeach having a terminal aperture for a first and second leg link fastenerrespectively.

In yet another embodiment, the disclosure relates to an orthopedicimplant system having an outline comprising a spanning link that extendsfrom 15 to 60 mm along a long axis and has two opposing terminal endsjoined across a short axis at a width of 2 to 5 mm by two opposing longsides and each of the terminal ends that each have a top surface andextend away from the long axis to collectively form a T-shape, and thelegs each have an eyelet defining a surface around an aperture in aplane at from 60 to 120 degrees relative to the top surface of therespective leg, and each of which receives a cross screw with at leastone being a polyaxial compression screw, and wherein the cross screwaxes are in differing planes that form an X-shape but which do notinterfere with each other.

In yet another aspect of the present disclosure, a method of using theaforementioned system is disclosed, including but not limited to in aminimally-invasive surgical setting.

The present disclosure has significant benefits across a broad spectrumof endeavors. Particular benefits and improvements over the prior artinclude: a vastly decreased footprint of plate; lesser prominence ofplate and screws; easier to insert/install; availability ofMIS/percutaneous applications; appropriate rigidity in an effort tominimize bone resorption; multi-planar fixation; screws inserted inplanes offset by about 90 degrees; permitting crossing screwtrajectories; avoiding intersecting screw trajectories; permittingconverging or diverging screw trajectories; providing a biomechanicallysuperior construct and overall structure; avoiding use of screws of alocking type; permitting a surgeon to hit dorsally and plantarly tominimize gapping; achieve even force distribution; greater compressionat the surgical site; and less risk of subsidence.

Potential indications/procedures for which the system and method of thepresent disclosure are particularly applicable include:Metatarsalphalangeal (MTP) fusions, Calcaneocuboid fusions,Talonavicular fusions, Navicularcueiform fusions, Lapidus (i.e., 1stmetatarsal cuneiform fusion, osteotomies of the 1st metatarsal), Anklefusions and others. In other embodiments, the systems and methodsdisclosed herein are applicable to joints and/or anatomical featuresoutside the foot and ankle region.

The phrases “at least one,” “one or more,” and “and/or,” as used herein,are open-ended expressions that are both conjunctive and disjunctive inoperation. For example, each of the expressions “at least one of A, Band C,” “at least one of A, B, or C,” “one or more of A, B, and C,” “oneor more of A, B, or C,” and “A, B, and/or C” means A alone, B alone, Calone, A and B together, A and C together, B and C together, or A, B andC together.

Unless otherwise indicated, all numbers expressing quantities,dimensions, conditions, and so forth used in the specification andclaims are to be understood as being approximations which may bemodified in all instances as required for a particular application ofthe novel systems and methods described herein.

It is expressly understood that where the term “patient” has been usedto describe the various embodiments of the disclosure, the term shouldnot be construed as limiting in any way. For instance, a patient couldbe either a human patient or an animal patient, and the systems andmethods described herein apply equally to veterinary science as theywould to surgical procedures performed on human anatomy. The system andmethods described herein therefore have application beyond surgicalprocedures on the foot and ankle, and the concepts may be applied toother types of “patients” and procedures without departing from thespirit of the present disclosure.

The term “a” or “an” entity, as used herein, refers to one or more ofthat entity. As such, the terms “a” (or “an”), “one or more” and “atleast one” can be used interchangeably herein.

The use of “including,” “comprising,” or “having” and variations thereofherein is meant to encompass the items listed thereafter and equivalentsthereof as well as additional items. Accordingly, the terms “including,”“comprising,” or “having” and variations thereof can be usedinterchangeably herein.

It shall be understood that the term “means” as used herein shall begiven its broadest possible interpretation in accordance with 35 U.S.C.,Section 112(f). Accordingly, a claim incorporating the term “means”shall cover all structures, materials, or acts set forth herein, and allof the equivalents thereof. Further, the structures, materials, or actsand the equivalents thereof shall include all those described in theSummary, Brief Description of the Drawings, Detailed Description,Abstract, and Claims themselves.

By way of providing additional context and to further satisfy thewritten description requirements of 35 U.S.C. § 112, the following areincorporated by reference in their entireties for the express purpose ofexplaining and further describing the various tools, implants and otherapparatus commonly associated with surgical procedures, including MISprocedures: U.S. Pat. No. 6,142,998 to Smith et al.; U.S. Pat. No.7,406,775 to Funk et al.; and U.S. Pat. No. 9,861,405 to Day et al.

The Summary is neither intended, nor should it be construed, as beingrepresentative of the full extent and scope of the present disclosure.Moreover, references made herein to “the present disclosure” or aspectsthereof should be understood to mean certain embodiments of the presentdisclosure and not necessarily be construed as limiting all embodimentsto a particular description. The present disclosure is set forth invarious levels of detail in the Summary as well as in the attacheddrawings and the Detailed Description, and no limitation as to the scopeof the present disclosure is intended by either the inclusion ornon-inclusion of elements or components when describing certainembodiments herein. Additional aspects of the present disclosure willbecome more apparent from the Detailed Description, particularly whentaken together with the drawings.

The above-described benefits, embodiments, and/or characterizations arenot necessarily complete or exhaustive, particularly as to thepatentable subject matter disclosed herein. Other benefits, embodiments,and/or characterizations of the present disclosure are possibleutilizing, alone or in combination, as set forth above and/or describedin the accompanying figures and/or in the description herein below.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated herein and constitutea part of the specification, illustrate embodiments of the disclosure,and together with the Summary and the Detailed Description serve toexplain the principles of these embodiments. In certain instances,details that are not necessary for an understanding of the disclosure orthat render other details difficult to perceive may have been omitted.It should be understood, of course, that the present disclosure is notnecessarily limited to the particular embodiments illustrated herein. Inthe drawings:

FIG. 1 shows a top perspective view of the system according to anembodiment of the present disclosure;

FIG. 2 shows a detailed perspective view of the system of FIG. 1;

FIG. 3 shows a top plan view of the system according to anotherembodiment of the present disclosure;

FIG. 4 shows a side perspective view of the system according to yetanother embodiment of the present disclosure;

FIG. 5 shows another side perspective view of the system according toyet another embodiment of the present disclosure;

FIG. 6 shows a side elevation view of the system according to yetanother embodiment of the present disclosure;

FIG. 7 shows a side perspective view of the system according to yetanother embodiment of the present disclosure;

FIG. 8 shows a top plan view of the system according to yet anotherembodiment of the present disclosure;

FIG. 9 shows another top plan view of the system according to yetanother embodiment of the present disclosure;

FIG. 10 shows a side perspective view of the system of FIG. 9;

FIG. 11 shows a top plan view of the system according to yet anotherembodiment of the present disclosure;

FIG. 12 shows a side elevation view of the system of FIG. 11;

FIG. 13 shows a perspective view of particular method steps according toan embodiment of the present disclosure;

FIG. 14 shows a perspective view of an additional method step accordingto an embodiment of the present disclosure;

FIGS. 15A-15C show detailed perspective views of the system and methodaccording to embodiments of the present disclosure; and

FIG. 16 shows a perspective view of an instrument for use with thesystems and methods according to embodiments of the present disclosure.

The foregoing drawing figures are not necessarily to scale. In certainfigures, more or less detail has been shown to streamline the disclosureand/or provide clarity to the illustrations. It is expressly understoodthat certain embodiments shown in any one of the foregoing drawingfigures may comprise other elements shown or described in relation toother embodiments, and that such combinations and sub-combinations areconsidered within the scope of the present disclosure.

DETAILED DESCRIPTION

It is the Applicant's intent that this specification and the inventionsdescribed herein be accorded a breadth in keeping with the scope andspirit of the disclosure and various embodiments disclosed, despite whatmight appear to be limiting language imposed by certain examplesdescribed in detail below. To acquaint persons skilled in the pertinentarts most closely related to the present disclosure, preferred and/orexemplary embodiments are described in detail without attempting todescribe all of the various forms and modifications in which the novelapparatus, devices, systems and methods might be embodied. As such, theembodiments described herein are illustrative, and as will becomeapparent to those skilled in the arts, may be modified in numerous wayswithin the spirit of the disclosure.

Embodiments of the present disclosure present several advantages overthe prior art including, for example, the speed and efficacy of theprocedure, the minimally invasive aspects of the procedure, thedisposability and/or reusability of components of the system, theability to introduce tools, instrument and components of the system to asurgical site with minimal risk of damage to the surrounding tissue,lower risk of infection, more optimally placed fasteners, decreased riskof components of the system becoming misaligned or dislodged, and fewerand/or less expensive components required for a particular surgery,among other advantages.

Referring now to FIGS. 1-16, certain embodiments of the presentdisclosure are shown. Referring to FIG. 1, the system 100 in varyingembodiments is comprised of components well suited for placement and useproximate to the Metatarsophalangeal joint. More particularly,components of the system 100 are adapted to be received against one ormore bodies to facilitate, for example, fusion between the one or morebodies. Other procedures for use with the system 100 of the presentdisclosure include, but are not limited to, Calcaneocuboid fusions,Talonavicular fusions, Navicularcueiform fusions, Lapidus, Ankle fusionsand other fusions of the foot and ankle. Details relating to thedifferent components used in these and other procedures are providedbelow.

Referring to FIG. 2, the system 100 may be comprised of one or morecomponents, and according to one embodiment comprises a plate 110. Theplate 110 preferably comprises a central portion and one or morearmatures 115. The armatures 115 preferably extend from the centralportion of the plate 110 and may be close to perpendicular to thelongitudinal or x-axis of the central portion. As shown in FIG. 2, theone or more armatures 115 are preferably arcuate or semi-arcuate inshape as the armatures 115 extend from the central portion of the plate110. The plate preferably comprises one or more apertures or bores 140,while the one or more armatures 115 preferably comprise a substantiallyhollow collar 118 for inserting or guiding one or more fasteners, suchas a cannulated, cortical or cancellous screw or similar fastener.

The bores 140 of the plate 110 may be oriented and/or aligned to permitfasteners, such as screws S2 to be inserted in a generally parallelmanner, while the collar(s) 118 may be aligned in a manner to permitfixations devices, such as screws S1 to be inserted in a generallyconverging manner, but without permitting any of the fasteners tointersect when inserted into the adjoining bodies. This providesnumerous benefits to the surgeon and the patient, such as orientingfixations devices in three orthogonal planes, as well as the otherbenefits addressed in the Summary.

To improve flexibility with respect to alignment of screws S1, thecollars 118 may be configured to receive a bushing 120. The outercircumference of the bushing 120 may be configured to closely match theinterior dimensions of the collar 118, such that the bushing 120 may bereceived and retained by the collar 118, including in either a threadedor non-threaded engagement. The collar 118 may comprise a rim or lip atits lower or bottom edge to prevent the bushing 120 from passing throughthe collar 118. The bushing 120 is preferably annular and may comprisean inner surface that has is part-spherical in cross-section. In anembodiment where the outer surface comprises a screw-thread, the bushing120 may be sized such that the screw-thread on the outer surfaceinterfaces with a complementary screw-thread lining the interior of thecollar 118.

In one embodiment, placement of the fasteners through the bores 140 andcollars 118 of the plate 110 permits a surgeon to accurately andsecurely place the plate 110 in its desired location and orientation,including as shown in FIGS. 1, 4, 5 10 and 12-14, so that the surgeondoes not need to worry about movement of the adjacent bodies, movementof the components of the system, misalignment of the armatures 115 andassociated collars 118, etc.

Each bushing 120, in turn, may comprise a substantially hollow openingfor receiving a screw S2, as shown in FIG. 2. The bushing 120 may beoriented in each collar 118 so as to provide freedom of movementdorsally or plantarly or medially, or a combination thereof. The degreeof freedom is determined by the orientation of the bushing 120 withinthe collar 118, which may be configured with increased or decreasedtolerances (relative to the bushings) to increase or decrease the degreeof freedom in orienting the bushings 120 and thereby the screws S2. Thefreedom of movement described above enables the screw S2 to rotaterelative to the longitudinal plane of the plate 110 by up to 30 degreesof neutral in either side, therefore providing a total arc of 60degrees.

Bushing 120 may further comprise an outwardly-extending protrusion or“key” 122 that protrudes radially from the outer surface of the bushing120. The key 122 is preferably sized complementary to a notch 112 in theinterior hollow surface of collar 118, as depicted in FIG. 2. The key122 is preferably on a proximal end of the bushing 120 (relative to theuser) so that the key 122 cannot engage the notch 112 until the bushing120 is received by and retained by the collar 118. The engagement of thekey 122 with the notch 112 prevents further rotation and preferablymovement of the bushing 120 relative to the collar 118, as described ingreater detail below.

Still referring to FIG. 2, a tool 150 may be used to position a screw S2through the bushing 120 and collar 118 in a desiredtrajectory/orientation as described herein. Due to the close tolerancesof the collar 118 and the bushing 120, and the bottom rim of the collar118 described above, the bushing 120 may not pass through the collar 118even when not engaged with the collar 118 in a threaded engagement. Thecollar 118 may alternatively be tapered, and it is to be expresslyunderstood that other means of providing a stop for the bushing 120relative to the collar 118 are contemplated. The screw S2 may alsocomprise a threaded head 130, which may be received within the bushing120 including by way of a threaded engagement.

Advancement of the screw within the bushing 120 (when placed within thecollar 118) may be achieved by tool 150 without disturbing the bushing120, as the shaft of the screws S2 is preferably narrower than theinterior dimension of the bushing 120. However, further advancement ofthe screw S2 that causes threaded engagement with bushing 120 willresult in rotation of the bushing 120, and ultimately engagement of thekey 122 in the notch 112 of the collar 118. Engagement of the key 122 innotch 112 prevents further rotation of the bushing 120 and thereby locksthe bushing 120 relative to the collar 118. This locking engagement isdepicted in FIG. 2. Any of the components described in this section maybe provided with a high-friction surface to facilitate this locking ofthe bushing 120 relative to the collar 120. Thus, in use, the screw S2may be threaded into the bushing until it reaches a limit of travel,whereupon further rotation of the screw S2 also rotates the bushing 120causing the radially extending key 122 to translate rotationally so asto engage with the notch 112.

Alternatively, the bushing 120 may comprise a groove for receiving ananti-rotation element. The anti-rotation element of this embodiment maycomprise a key for engaging with the notch of the collar, as describedabove, rather than the bushing itself. Upon insertion of the screw, theinitial threaded portion passes through the bushing from the upper sideof the plate and into the underlying bodies. The threaded screw headthen begins to engage with the internal thread of the bushing. As thethread advances, the friction begins to rotate the bushing within thecavity. The anti-rotation element is engaged within the groove of thebushing, and is unable to rotate with the bushing once the key hasengaged with the notch. Accordingly, the friction between thesecomponents and the engagement between the key and the notch create aninterference frictional fit, thereby locking the assembly in a desiredaxial alignment. In embodiments, the anti-rotation element is circularand sized to be placed securely on an outer circumference of the bushingand within a groove in the bushing. The groove does not necessarilyextend about an entire perimeter of the bushing. In other embodiments,the anti-rotation element is substantially in the shape of a “C” and theanti-rotation element may be selectively removed from the bushing ifdesired, thereby changing the assembly from a locking type to anon-locking type. Alternatively, the key described herein may beselectively retractable relative to the anti-rotation element, therebypermitting the assembly to change from a locking to a non-locking typewithout deviating from the other aspects of the assembly describedherein.

In yet another alternative embodiment, the bushing may be provided withno threading in the hole, the hole having a tapered configuration, and ascrew may be provided with a tapered section for cooperation with thistapered hole in the bushing. Provided a force is applied in the axialdirection which drives the tapered section of the screw into the taperedsection of the bushing, rotation of the screw will result in rotation ofthe bushing and the locking mechanism of the polyaxial assembly willactivate. Such a force may for example be applied in the instance thatthe screw has a lower section which is screwed into a substrate,resulting in a force which pulls the upper tapered section of the screwinto the tapered hole of the bushing.

Thus, in embodiments, the inner surface of the recess is configured totaper from a proximal surface of the plate, relative to the user, to adistal surface of the plate. A bushing may be secured within the taperedrecess by a frictional or interference fit between the bushing and therecess after being advanced within the recess by a predetermineddistance. In embodiments, the bushing is permitted to pivot whileretained by the recess, prior to being secured. This in turn allows thescrew orientation to be adjusted relative to the plate.

As shown in FIGS. 1 and 2, the plate 110 is configured to be positioneddorsally, in one placement of the system, while the armatures extendaway and downwardly from the central portion of the plate 110 such thatthe collars 118 are oriented in a generally facing direction relative tothe adjacent bodies. This configuration in turn permits screws or otherfasteners to be inserted in a converging but complementary manner, andwithout risk of intersecting one another. This configuration alsopermits screws or other fasteners (S1, S2) to be oriented in multipleorthogonal planes, while also permitting converging trajectories,thereby greatly improving compression and simultaneously avoidingundesired collision among the different fasteners.

The plates 110 described herein may further comprise one or morefenestrations 117, 119, which in certain embodiments are located andsized to accommodate 2 mm or other sized K-wires. The placement ofK-wires and other temporary fasteners may be used to temporarilyposition and/or stabilize the plate 110 prior to insertion of permanentfasteners. The fenestrations may be different in size and/or shape toaccommodate placement of other tools, implants, etc. In certainembodiments, no fenestrations are provided with the plate.

Any of the fasteners or screws referred to herein may be temporary orpermanent during a fusion or other surgery practiced using the systemsor methods described herein. Screws and other fasteners used with thesystems and methods described herein may be locking or non-locking type.By way of example but not limitation, the screws S1 may beself-drilling, self-tapping poly-axial locking screws. The screws may becortical or cancellous, however, as the diameter of the screw isincreased, the resistance to fatigue and ultimately failure alsoincreases. Therefore, cortical screws are preferred over cancellousscrews. Alternatively, screws may have a larger than standard corediameter to account for this issue.

Any of the fasteners described herein may be used with or withoutpre-drilled holes in the underlying boney anatomy. In the embodimentwhere pre-drilled holes are employed, the diameter of the drill ispreferably smaller than that of the core diameter of the screw such thatinsertion of the screw causes radial expansion and impaction of thesurrounding bone. This in turn improves pull-out resistance.Furthermore, the fasteners may be inserted through the bores 140 and/orcollars 118 by only making very small incisions, and in embodimentsdescribed herein may be performed via MIS procedures.

In embodiments, the system may be referred to as an orthopedic implantsystem. The system preferably comprises a central portion or spanninglink having a longitudinal axis in the x direction. The spanning link isconfigured to receive at least one fastener. The fastener received bythe spanning link preferably has an axis which forms an angle relativeto the spanning link's longitudinal axis in the range of 80 degrees to100 degrees. The spanning link may comprise a first leg link extendingaway in the y and z direction (as taken from the longitudinal axis inthe x direction), which has an aperture for receiving, for example,another fastener. This fastener preferably has an axis that extends awayfrom the first leg link fastener aperture in the direction of but notintersecting the axis of the fastener received by the spanning link. Inone embodiment, the first leg link extends away in both the y and zdirection to form a curve that defines at least 60 degrees of an arc.

In certain embodiments, the first leg link aperture defines a planewhich is not parallel to the spanning link's longitudinal axis. In yetanother embodiment, the implant system comprises a second leg linkextending away from the spanning link in the y-z direction and having alength that may be the same as or different from the first leg linklength. The second leg link preferably has an aperture which receives afastener, and that fastener has an axis that extends away from thesecond leg link fastener aperture. In a preferred embodiment, the secondleg link fastener axis is in the direction of a desired area of fusionfor a particular surgery. Also, the first leg link fastener axis and thesecond leg link fastener axis preferably converge toward each other, butdo not intersect or otherwise cause interference between the two leglink fasteners.

In embodiments, the second leg link aperture defines a plane which isnot parallel to the spanning link's longitudinal axis. In otherembodiments, the first leg link defines an arc of more than 45 degreesrelative to the spanning link's longitudinal axis. In still otherembodiments, the first leg link defines an arc of more than 75 degreesrelative to the spanning link's longitudinal axis.

The first leg link length and the second leg link length are notnecessarily the same. In one embodiment, the spanning link has a lengthof 15 to 60 mm, a width of 2 to 5 mm, and a thickness of 1 to 2.5 mm,and the first leg link has a length of 8 to 20 mm extending from thefirst spanning link and a width of 2 of 5 mm and a thickness of 1 of 2.5mm.

In embodiments, the first and second leg links are formed of a materialto cuase the leg links to flex in response to a force applied to thesame. The first leg link or the second leg link may form an arc of atleast 85 degrees in the z direction.

The fasteners described above preferably have at least 30 degrees ofconical freedom about their axes, and in another embodiment have atleast 40 degrees of conical freedom. The first and second leg linkfasteners preferably cross one another, although in differing planes, toform an X-shape. However, even with the above-recited degrees offreedom, the two fasteners do not contact each other. One or more of theleg link fasteners may contact an extension of the spanning link and byreceived by the extension, such as the distal tip of a fastener beingthreaded into an aperture in the extension.

In FIG. 3, an alternate embodiment of the present disclosure is shown ina top plan view. The plate 110 is similar to the ones described above,and the content relating to the plate of FIG. 2 is incorporated here byreference. The plate 110 of FIG. 3 comprises an extension 113 having anaperture for capturing the distal end of a screw S1 inserted through theopposite collar 118, as shown in FIG. 3. In this manner, the screw S1can be captured and retained by the extension 113, which both providesrigidity of the screw S1 and prevents subsidence after implantation, andalso ensures proper alignment of the screw S1 along a trajectoryintersecting the aperture of the extension 113. The aperture ispreferably threaded with a female thread to receive the threaded end ofthe screw S1. In this manner, the screw S1 passing through the apertureprovides stability and rigidity, while the other screw S1 (which in apreferred embodiment is only partially threaded) is configured toprovide compression through introduction in the underlying boneyanatomy.

Referring now to FIG. 4, one particular orientation of the plate andfasteners described above is shown. In this arrangement, the plate 110is positioned to address a Lapidus indication, whereby the armatures andterminating collars are positioned plantarly. Here, the primaryfasteners are inserted through the collars of the armatures in acrossing but non-intersecting manner to facilitate a fusion of the firstTMT joint, such as in a Lapidus procedure. FIG. 5 illustrates anotherorientation for facilitating a Lapidus procedure, wherein the armaturesand collars are positioned dorsally. The system may be positioned inother manners than shown in FIGS. 4-5 while still achieving the benefitsdescribed above, including in other fusion and non-fusion surgicalprocedures.

In one embodiment, the fasteners are prohibited from contacting oneanother, but nonetheless converge to pass close to one another toachieve the greatest possible compressive strength when coupled to theplate. Furthermore, the fasteners may be desirably oriented relative tothe z-axis so as to avoid the fasteners passing only partially throughthe dense area of the adjacent bodies where subsidence is less likely tooccur, and also to avoid gapping in certain areas of the joint.Secondary fasteners may also be inserted through the bores in the platewithout interfering with the primary fasteners. The placement of theplate is such that there is adequate boney anatomy for the fasteners tobe inserted without penetrating the bodies, and without intersectingeach other.

The armatures may be oriented at more of a tangential angle relative tothe central portion of the plate. This may permit placement of the platemore medially, or to conform more closely to the general shape of theadjacent bodies and thereby avoid discomfort to the patient.

FIG. 6 shows a side elevation view of a system according to anotherembodiment. This view is particularly helpful in showing the multipleplanes in which the fasteners are oriented, even more particularly howthe fasteners may be positioned in three orthogonal planes to improvestrength and resist movement. In this embodiment, the plate 110comprises two differently sized armatures 115, 115′ with one of thearmatures 115′ being shorter than the other 115. This permits the collarof the first armature 115′ to be offset in the z-axis from the othercollar of the longer armature 115. This system may be beneficial toensure placement of fixations devices in multiple bodies at desiredareas (i.e., bone density) or to further avoid collision of fastenersused in a relatively small area. FIG. 7 depicts another embodiment whereonly a single armature 115′ is provided. The other aspects of the systemdescribed above apply equally to the components of these embodiments ofFIGS. 6 and 7 and are incorporated herein by reference.

A person of ordinary skill in the art will recognize that the foregoingembodiments convey various manners of transmitting torque from a screwto a bushing so as to rotate the bushing and lock the bushing relativeto a collar in which the bushing is placed. One of ordinary skill willappreciate that other means may be provided for this objective, and thatthe screw may be replaced with a bolt or equivalent component. In onealternate embodiment, the bushing may comprise a “slotted” upper surfaceto receive a flat-bladed or Phillips style screwdriver. One of ordinaryskill will also appreciate that with the bushing in position within thecollar of the armature, the bushing could then be rotated by means of ascrewdriver until the key engages with the notch described above, sothat the bushing locks in place in a desired orientation. Any screw orbolt or other item may then be attached to the bushing or driven throughit with its axis in a particular desired orientation as then defined bythe locked-in position of the bushing.

According to various embodiments described herein, the apertures forreceiving primary fasteners (i.e., screws) are offset from the centralportion of the compression plate. The offset nature of the apertures andthe position of the armatures relative to the central portion of theplate provides for a more optimal placement and orientation of thefasteners relative to the joint. This is especially true when insertingthe fasteners in a small area, in a difficult location or in a MISapplication.

Referring now to FIG. 8, another embodiment of the present disclosure isshown. Here, the plate 110 comprises an extension 125 that includes anadditional bore 140′. This additional bore 140′ facilitates placement ofan additional fastener, thereby strengthening the connection between theplate and the underlying bodies. In this embodiment, one of the screwsS1 may be captured as described above in relation to FIG. 3, although inother embodiments the screws S1 are not captured as shown in FIG. 2.

A greater or fewer number of bores and/or fenestrations may be providedwithout departing from the inventive concepts described herein. Forexample, FIG. 9 depicts a modified plate 110 that comprises four bores140. In addition, this plate 110 also comprises a third armature forplacement of an additional screw. Variations on the embodiments of FIGS.8 and 9 are contemplated and considered within the scope of the presentdisclosure.

FIG. 10 shows the system of FIG. 9 positioned against the underlyingboney anatomy. In this manner, the guide may be useful in a MTP fusion,and further beneficial in the sense the plate provides both dorsal andplantar-positioned collars for introducing fixations devices into thebodies, further assuring solid compression and avoiding gapping.

FIG. 11 shows a plate 110 having armatures 115 only about onelongitudinal end of the central portion of the plate 110. Thisconfiguration is particularly beneficial when addressing Lapidusindications. The screws 51 may be retained by any of the bushingsdescribed above, including with the anti-rotation element. Accordingly,applicant incorporates those paragraphs of the Detailed Descriptionherein by reference. FIG. 12 is the system of FIG. 11 shown with theunderlying bodies, which may be used in a Lapidus surgery as describedabove in relation to FIG. 4.

According to embodiments, the armatures may reach from 60 to 120 degreesin range, unlike many plates that permit only 90 degree orientations.This is particularly beneficial for procedures on the foot and ankle,where degrees of freedom and corresponding flexibility allow a surgeonto perform procedures that are not permissible with current state of theart plate and screw systems. It is to be expressly understood that theplate and armatures described herein may be curved or angled to conformclosely to the surrounding patient anatomy. The material of the plateand other components of the systems described herein may comprisestainless steel, titanium, titanium alloy, aluminum alloy, chromiumalloy, vanadium and other metals or metal alloys. The components mayfurther comprise PEEK, carbon fiber, polyurethane, polyethylene, ABSplastics, photo-polymers, resins, fiber-encased resinous materials,rubber, latex, synthetic rubber, synthetic materials, polymers, andnatural materials.

Referring now to FIG. 13, an embodiment is shown where the centralportion of the plate does not include extensions or armatures. This typeof component may be particularly desirable for use in MIS applications.The general benefits of the system and methods described above in theSummary and Detailed Description are still achieved with this particularembodiment.

In FIG. 13, the plate 110 has been slightly elevated from the underlyinganatomy to illustrate how adjacent bodies may be prepared in advance bya surgeon to achieve even greater alignment and compression wheninstalling the system in its varying embodiments. For instance, theboney anatomy may be cut, drilled or debrided 210, 220 to allow oppositeends of the plate and the corresponding bores 140 to rest congruentlyalong the surfaces removed by the surgeon. This site preparation may bequickly and easily performed and assist in placement of the componentsof the system described herein.

The preparation by cutting, drilling or debriding 210, 220 describedabove may also be performed in a manner so that any armatures associatedwith the plate 110 are required to deflect slightly in order to bepositioned on the adjacent bodies, thereby creating an interference fitor snap-fit. The frictional engagement may also help increasecompressive strength of the plate 110. However, it is not necessary toperform preparation of the surgical site in order to utilize thebenefits of the system and methods described herein.

Methods of performing procedures using the aforementioned system arealso within the scope of the present disclosure. Referring now to FIGS.13-14, various stages or steps of the system being used in a surgicalsetting are shown. Although depicted relative to a foot joint, it isexpressly understood that other joints and other adjacent bodies mayemploy the following systems and methods with equal efficacy. In FIG.13, the plate 110 is shown positioned next to the adjacent bodies wherecompression is needed to ensure a successful fusion, to use one example.The plate 110 may be positioned without secondary fasteners and in alocation where the plate 110 spans the joint between the adjacentbodies. The bodies may have been prepared in advance, such as by cuttingor otherwise removing the surfaces (as described above) that wouldotherwise interfere with placement of the compression plate. In FIG. 14,an insertion instrument 250 is shown being inserted through one of thebores 140. Other instruments may comprise any of those known to a personof ordinary skill in the art for cutting, drilling, debriding, shavingor removing boney anatomy.

According to one embodiment, the system and method may comprise the useof one or more inserts. The inserts, such as insert 200 shown in FIG.14, may have surfaces that are adapted to receive a fastener such as ascrew and enhance the plate's 110 ability to promote crossing butnon-intersecting placement of the fasteners therethrough and, onceinserted, ensures that the adjacent bodies are in compression and thatthe fasteners will not subside during the surgery and recovery by thepatient.

Referring again to FIG. 14, inserts 200 may be placed within one or morebores 140 of the plate 110 and further direct the fasteners through theplate 110. These inserts 200 may extend outwardly from the proximalsurface of the plate 110, may extend inwardly from the distal surface ofthe plate 110, or may be positioned substantially flush with the plate110, depending on the surgeon's preference and the particular demands ofthe surgical procedure to be performed. In one embodiment, the boneyanatomy of the patient may be prepared (as described above in FIG. 13)to allow a surgeon to countersink the inserts 200 into the adjacentbodies. In embodiments, the insert 200 comprises a cam, a slope orequivalently-shaped surface to provide a pre-determined orientation to ascrew or equivalent fastener, relative to the plate 110 that receivesthe insert 200.

The inserts 200 further promote use of the compression plate in a MISprocedure. Further illustration of the aspects of this particularembodiment is provided in FIGS. 15B-C. It is to be understood that thesystem of FIGS. 15A-C is preferably for use in a MIS procedure. Theplate of this embodiment has a central portion, and two armatures havingrecesses at their distal ends. As distinguished form the embodiment ofFIG. 2, however, the armatures extend parallel to the longitudinal orx-axis of the plate's central portion. In this embodiment, the fastenersmay still converge and cross one another, albeit in different planes soas not to contact one another. This may be achieved, for example, by theorientation of the apertures of the inserts, or by the orientation ofthe apertures in the first and second armatures.

FIG. 15A illustrates the unique placement of the fasteners once placedthrough the compression plate and its inserts. The trajectories T1, T2of the fasteners are shown as converging but having complementary planesso that, while not permitted to contact one another, generally achievethe greatest degree of compression by virtue of their respectivevectors. The close placement of the converging fasteners also reducesthe chance of gapping and misalignment of the joint after thecompression plate has been secured to the adjacent bodies. The range ofallowable trajectories for each of the fasteners may be configured via aselection of various inserts, each of which features a differentpre-defined orientation relative to the holes of the plate.

FIG. 16 show a tool 350 according to one embodiment, which assists asurgeon in placement of a first and a second fastener through the plate.As shown, the tool 350 closely mimics the functionality of a jig,whereby the tool 350 permits registration via a primary fastener, oralternatively a temporary fastener 310. The tool 350 may compriseadjustable settings 320, 340 to lock the tool 350 in the preciselocation. The tool 350 is preferably adjustable in various dimensions,including by adjustment of the position of a first and a secondalignment head 315 relative to the respective first and secondapertures. Thus, an alignment head 315 may be positioned against any onefastener and then be adjusted to position the other alignment head 315in the desired location for a second fastener. The alignment heads 315provide the necessary alignment of the fasteners and may compriseindicia to facilitate the proper alignment. The use of multipleregistration points allows a user to ensure that the tool is properlypositioned before making adjustment to the adjustment heads. One or moreof the registration points may be based upon a locking or non-lockingfastener, a temporary or permanent fastener, or alternatively a segmentof the plate or the inserts thereto. The tool 350 may also comprise ahandle for positioning by the surgeon, and may comprise dials or gaugesas depicted in FIG. 16.

Although specific aspects shown in these Figures are not expresslydescribed, it should be understood that any of the features describedabove in connection with other embodiments apply equally to theembodiments of FIGS. 1-15C.

One having skill in the art will appreciate that embodiments of thepresent disclosure may have various sizes. The sizes of the variouselements of embodiments of the present disclosure may be sized based onvarious factors including, for example, the anatomical variances of thepatient, the person or other device operating with or otherwise usingthe components of the system, the surgical site location, physicalattributes of the bodies and other anatomical features of a particularpatient, and other dimensional variations including, for example, width,length and thickness, and the size of associated surgical tools orfasteners.

Any of the components described herein may be sized to only completementother components in a specific segment of the system, such as an insertbeing sized to only be received by a particular bore or collar of thesystem. Further, certain component(s) may comprise surface finishing,such as by electroplating, to imbue the components with coloring,shading, cross-hatching or other visually or tactile-observable featuresin order to aid identification of the component(s). Indicia may beincluded on the plate and/or segments of the plate to indicate aparticular insert, screw, fastener, etc. to be used with that particularsegment, or to indicate a sequence or order of performing various stepswith the system described above. Indicia may also appear on aninstrument or tool indicating which area of the system the particularinstrument or tool is to be used, a direction for placing the instrumentor tool, identifying a body or anatomical feature or landmark foraccessing with the instrument or tool, etc.

While various embodiments of the present disclosure have been describedin detail, it is apparent that modifications and alterations of thoseembodiments will occur to those skilled in the art. However, it is to beexpressly understood that such modifications and alterations are withinthe scope and spirit of the present disclosure, as set forth in thefollowing claims. For example, certain geometries have been shown wherean armature is on one medial side of a plate, but could be reversed andstill provide the same benefits as described herein. Similarly,armatures and collars could be lengthened or shortened or substitutedfor extensions, as described above, without departing from the novelconcepts captured by the appended claims.

The foregoing discussion of the disclosure has also been presented forpurposes of illustration and description. The foregoing is not intendedto limit the disclosure to the form or forms disclosed herein. In theforegoing Detailed Description for example, various features of thedisclosure are grouped together in one or more embodiments for thepurpose of streamlining the disclosure. This method of disclosure is notto be interpreted as reflecting an intention that the claimed disclosurerequires more features than are expressly recited in each claim. Rather,as the following claims reflect, inventive aspects lie in less than allfeatures of a single foregoing disclosed embodiment.

The present inventions, in various embodiments, include components,methods, processes, systems and/or apparatuses substantially as depictedand described herein, including various embodiments, subcombinations,and subsets thereof. Those of skill in the art will understand how tomake and use the present inventions after understanding the presentdisclosure. The present inventions, in various embodiments, includeproviding devices and processes in the absence of items not depictedand/or described herein or in various embodiments hereof, including inthe absence of such items as may have been used in previous devices orprocesses, e.g., for improving performance, achieving ease and\orreducing cost of implementation.

Moreover, though the present disclosure has included description of oneor more embodiments and certain variations and modifications, othervariations and modifications are within the scope of the disclosure,e.g., as may be within the skill and knowledge of those in the art,after understanding the present disclosure. It is intended to obtainrights which include alternative embodiments to the extent permitted,including alternate, interchangeable and/or equivalent structures,functions, ranges or steps to those claimed, whether or not suchalternate, interchangeable and/or equivalent structures, functions,ranges or steps are disclosed herein, and without intending to publiclydedicate any patentable subject matter.

What is claimed is:
 1. A surgical system, comprising: a plate comprisingone or more armatures, each of the one or more armatures offset from andextending about 90 degrees to the x-axis of the plate; the platecomprising at least one bore configured to receive a first screworiented in a z-axis relative to the plate; the one or more armaturescomprising a recess located at a distal end of the armature and havingan inner surface; a bushing having an outer surface complementary to theinner surface of the recess and configured to be selectively received byand retained by the recess, wherein the bushing further comprises athrough hole accessible via the recess when the bushing is retainedtherein; a second screw comprising a threaded portion, a non-threadedportion and a screw head having an outer surface complementary to thethrough hole of the bushing, wherein the threaded and non-threadedportions of the second screw pass through the through hole of thebushing, and wherein the outer surface of the screw head is configuredto be retained within the through hole of the bushing, and wherein thesecond screw is oriented in the direction of and normal to theorientation of the first screw.
 2. The surgical system of claim 1,wherein rotation of the screw once the screw head is retained within thebushing rotates the bushing relative to the recess.
 3. The surgicalsystem of claim 2, wherein further rotation of the bushing secures theposition of the bushing relative to the recess, thereby securing thebushing and the screw in a fixed orientation relative to the plate. 4.The surgical system of claim 3, wherein the inner surface of the recesstapers from a proximal surface of the plate to a distal surface of theplate, and wherein the bushing is secured within the recess by africtional or interference fit between the bushing and the recess afterbeing advanced within the recess by a predetermined distance.
 5. Thesurgical system of claim 3, wherein the bushing is permitted to pivotwhile retained by the recess but prior to being secured in the recess,allowing the screw orientation to be adjusted relative to the plate. 6.The surgical system of claim 3, wherein the screw head comprisesthreading on the outer surface and the through hole of the bushingcomprises a complementary threading to the threading on the outersurface of the screw head, and wherein the bushing retains the screwhead by threaded engagement between the screw head and the bushing. 7.The surgical system of claim 3, wherein the bushing further comprises agroove located about an outer circumference of the bushing and adaptedto receive an anti-rotation element within the groove.
 8. The surgicalsystem of claim 7, wherein the anti-rotation element is configured to bepositioned within the groove of the bushing, the anti-rotation elementfurther comprising a key for engagement with a notch on the innersurface of the recess.
 9. The surgical system of claim 8, wherein theanti-rotation element is substantially circular.
 10. The surgical systemof claim 8, wherein the anti-rotation element is c-shaped.
 11. Thesurgical system of claim 10, wherein the anti-rotation element may beselectively removed from the groove of the bushing.
 12. The surgicalsystem of claim 7, wherein the groove does not extend about an entireouter circumference of the bushing.
 13. The surgical system of claim 8,wherein the rotation of the bushing causes the key of the anti-rotationelement to engage the notch of the inner surface of the recess andprohibit further rotation of the bushing.
 14. The surgical system ofclaim 1, wherein the plate comprises two armatures, each of thearmatures comprising a recess having an inner surface for respectivelyreceiving and retaining a first and second bushing, each of the firstand second bushings comprising a groove located about an outercircumference of the bushing and adapted to receive an anti-rotationelement within the groove, the anti-rotation elements configured to bepositioned within the grooves of the bushings, each anti-rotationelement further comprising a key for engagement with a notch on theinner surface of the recess and locking the bushings relative to therecesses when the key engages the notch of the inner surface of thebushing.
 15. The surgical system of claim 14 further comprising: a thirdscrew configured to be received by the second bushing; wherein thearmatures are located on opposing ends of the plate, and wherein thesecond and third screws are oriented to converge towards one anotherwhile avoiding contact; and wherein the first, second and third screwsare oriented in three orthogonal planes.
 16. The surgical system ofclaim 1, wherein the at least one bore is located at a distal end of theplate and about the x-axis of the plate.
 17. A surgical assembly,comprising: a thin plate having first and second sides, the thin platecomprising one or more cylindrical bores extending therethrough; thethin plate further comprising two or more armatures extending from thefirst or second side of the plate; the two or more armatures comprisinga recess having an inner surface and a notch located along the innersurface; each of the two or more armatures adapted to receive a bushingconfigured to fit within the recess of the corresponding armature andhaving an outer profile that is complementary to the inner surface ofthe recess within which it is received, the bushings permitted to pivotor rotate within the recesses; each bushing having at least oneoutwardly-extending protrusion; and wherein the bushing is preventedfrom pivoting or rotating once the outwardly-extending protrusionengages the notch along the inner surface of the recess.
 18. Thesurgical assembly of claim 17, further comprising a screw adapted foroperative engagement with a threaded hole of the bushing, whereinrotation of the screw beyond a predetermined amount rotates the bushingwhich urges the outwardly-extending protrusion to engage the notch andlock the position of the bushing relative to the thin plate.
 19. Thesurgical assembly of claim 17, wherein the two or more armaturescomprise a first armature having a curved shape and having a firstrecess offset from the x-axis of the thin plate by about 90 degrees, andfurther comprising a second armature having a curved shape and having asecond recess offset from the x-axis of the thin plate by about 90degrees.
 20. The surgical assembly of claim 19, wherein the first andsecond armatures extend from the same side of the thin plate.
 21. Thesurgical assembly of claim 19, wherein the first and second armaturesextend from opposite sides of the thin plate.
 22. The surgical assemblyof claim 19, wherein the first and second armatures comprise differentlengths.
 23. The surgical assembly of claim 19 further comprising athird armature and a corresponding third recess.
 24. The surgicalassembly of claim 17, wherein the bushings are secured within therecesses by a frictional or interference fit.
 25. The surgical assemblyof claim 17, wherein the at least one outwardly-extending protrusion isselectively retractable, thereby allowing the bushing to pivot or rotatefreely when the outwardly-extending protrusion is retracted.
 26. Thesurgical assembly of claim 17, wherein the recess tapers from a proximalsurface of the thin plate to a distal surface of the thin plate.
 27. Thesurgical assembly of claim 26, wherein the outer surface of the bushingtapers to a matching degree as the recess.
 28. The surgical assembly ofclaim 18, wherein the screw is a cortical bone screw, a cancellous bonescrew or a cannulated bone screw.
 29. An orthopedic implant system whichcomprises a spanning link having a longitudinal axis in the x directionand having a first spanning link fastener with a first spanning linkfastener axis which forms an angle relative to the spanning linklongitudinal axis from 80 degrees to 100 degrees, and a first leg linkextending away in the y and z direction from the of the spanning linklongitudinal axis and having a first leg link fastener aperture thatreceives a first leg link fastener which has a first leg link fasteneraxis that extends away from the first leg link fastener aperture in thedirection of but not intersecting the first spanning link fastener axis.30. The orthopedic implant system as set forth in claim 29, wherein thefirst leg link forms a curve that defines at least 60 degrees of an arc.31. The orthopedic implant system as set forth in claim 29, wherein thefirst leg link length and the second leg link length are not the same.32. The orthopedic implant of claim 29, wherein one of the first leglink and the second leg link forms an arc of at least 75 degrees in thez direction.
 33. The orthopedic implant of claim 32, wherein one of thefirst leg link or the second leg link forms an arc of at least 85degrees in the z direction.
 34. The orthopedic implant of claim 29,wherein the long spanning link has a length of 15 to 60 mm, a width of 2to 5 mm, and a thickness of 1 to 2.5 mm, and the first leg link has alength of 8 to 20 mm extending from the first spanning link and a widthof 2 of 5 mm and a thickness of 1 of 2.5 mm.
 35. The orthopedic implantas set forth in claim 29, wherein the spanning link further comprises anextension.
 36. The orthopedic implant as set forth in claim 35, whereinthe extension includes an aperture configured to receive a fastener. 37.The orthopedic implant as set forth in claim 35, wherein the extensionreceives the distal end of one of the fasteners.
 38. An orthopedicimplant system having an outline consisting of a single spanning linkthat extends from 15 to 60 mm along a long axis and has two opposingterminal ends joined across a short axis at a width of 2 to 5 mm by twoopposing long sides, and each of the terminal ends include a throughaperture each of which receives a cross screw at least one the crossscrews being a polyaxial compression screw, and wherein the cross screwaxes are in differing planes and form an X-shape but which do notcontact each other.
 39. An implant which comprises a first long curvedspanning link having a top surface and a medial line along its lengthand a first end having a first ear having a first fastener aperture anda second end having a second ear having a second fastener aperture andthe long spanning link is fixed at the first end by a first fastenerthat extends through the first fastener aperture at 90 degrees +/−10degrees to the medial line of the spanning link and aperture and thelong spanning link is fixed at the second end by a second fastener thatextends through the second fastener aperture at 90 degrees +/−10 degreesto the medial line of the spanning link, a first leg link and a secondleg link each extending away from the medial line of the spanning linkand the first leg link and the second leg link each having a terminalaperture for a first and second leg link fastener respectively.
 40. Anorthopedic implant system having an outline comprising a spanning linkthat extends from 15 to 60 mm along a long axis and has two opposingterminal ends joined across a short axis at a width of 2 to 5 mm by twoopposing long sides and each of the terminal ends that each have a topsurface and extend away from the long axis to collectively form aT-shape, and the legs each have an eyelet defining a surface around anaperture in a plane at from 60 to 120 degrees relative to the topsurface of the respective leg, and each of which receives a cross screwwith at least one being a polyaxial compression screw, and wherein thecross screw axes are in differing planes that form an X-shape but whichdo not interfere with each other.